RESUMEN
Background: Higher education is widely recognized as a strategy to mitigate food insecurity. However, marginalized and racialized groups, especially Latinos, often do not experience the same economic and health benefits from their educational achievements as non-Latino Whites, highlighting a pattern of diminished returns within these communities. Aims: This study aims to explore the disparities in how educational attainment influences marital status and employment, and subsequently, food insecurity among Latino and non-Latino adults. Methods: Utilizing data from the 2022 National Health Interview Survey (NHIS), which encompassed 27,648 adults from both Latino and non-Latino backgrounds, this research applied a structural equation model to examine the relationship between educational attainment, ethnicity, and food insecurity. The study specifically focused on the mediating roles of marital status and employment. Results: Findings reveal significant interactions between education and ethnicity affecting marital status and employment, both of which serve as protective factors against food insecurity. These results indicate that higher levels of unemployment and lower marriage rates may disproportionately escalate food insecurity among Latinos, irrespective of educational attainment. Conclusion: The study highlights profound societal and environmental obstacles that prevent Latinos from leveraging educational achievements to improve their marital and employment statuses, and thereby, their food security. Addressing these disparities demands targeted interventions directed at Latino communities to bridge gaps in employment and marriage rates stemming from educational disparities. A holistic strategy that transcends mere access to education is essential to dismantle the societal barriers that undermine the educational dividends for Latino communities.
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Escolaridad , Empleo , Inseguridad Alimentaria , Hispánicos o Latinos , Humanos , Hispánicos o Latinos/estadística & datos numéricos , Masculino , Femenino , Empleo/estadística & datos numéricos , Adulto , Persona de Mediana Edad , Estados Unidos , Composición Familiar , Etnicidad/estadística & datos numéricos , Estado Civil/estadística & datos numéricos , Estructura FamiliarRESUMEN
Background: Hispanics/Latinos of Dominican background living in United States (US) have the highest hypertension prevalence compared with other Hispanic/Latino persons. Objective: To understand cardiovascular health among Dominicans, we evaluated hypertension prevalence and risk factors among Dominicans from the US and Dominican Republic (DR) using data from Hispanic Community Health Study/ Study of Latinos [HCHS/SOL] and the Prevalencia de Hipertension Arterial y Factores de Riesgo Cardiovasculares en la República Dominicana al 2017 (ENPREFAR-HAS 17) study. Methods: Hypertension was defined as blood pressure ≥140/90 mmHg, self-reported hypertension, or antihypertensive use. Exposures included sociodemographic/socioeconomic, clinical, and lifestyle/behavioral characteristics. Weighted generalized linear models were used to estimate associations between study characteristics and hypertension prevalence (PR = prevalence ratio), age-and-sex adjusted. HCHS/SOL (n = 1,473, US Dominicans; mean age 41 years, 60.4% female) was analyzed with survey procedures, while ENPREFAR-HAS 17 (n = 2,015 DR Dominicans; mean age 40 years, 50.3% female) was analyzed with statistical analyses for simple random sampling. Results: Hypertension prevalence was 30.5% and 26.9% for DR and US Dominicans, respectively. Hypertension control was low in both cohorts (36.0% DR, 35.0% US). Alcohol use among DR Dominicans was inversely associated with hypertension prevalence (PRDR = 0.8) with no association among US Dominicans. In both settings, diabetes (PRDR = 1.4; PRUS = 1.4) and obesity (PRDR = 1.8; PRUS = 2.0) were associated with greater hypertension prevalence in Hispanics/Latinos of Dominican background. Physical activity was lower among US Dominicans (PR = 0.80) but higher among DR Dominicans (PR = 1.16); all p < 0.05. Conclusions: Variations in social, lifestyle/behavioral, and clinical characteristics associated with hypertension among Dominicans in the US and DR were identified, suggesting that social context and cultural factors matter among immigrant populations.
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Hispánicos o Latinos , Hipertensión , Humanos , Masculino , Femenino , Hipertensión/epidemiología , Hipertensión/etnología , Prevalencia , Hispánicos o Latinos/estadística & datos numéricos , Adulto , República Dominicana/etnología , República Dominicana/epidemiología , Persona de Mediana Edad , Estados Unidos/epidemiología , Factores de Riesgo , Estudios TransversalesRESUMEN
BACKGROUND: Pre-exposure prophylaxis (PrEP) is a highly effective pharmaceutical intervention that prevents HIV infection, but PrEP uptake across the US has been slow among men who have sex with men (MSM), especially among Black/African American (B/AA) and Hispanic /Latino (H/L) MSM. This study investigates the acceptability and essential components of a peer-driven intervention (PDI) for promoting PrEP uptake among MSM, with a specific focus on B/AA and H/L communities. METHODS: We conducted 28 semi-structured, qualitative interviews with MSM in southern New England to explore the components of a PDI, including attitudes, content, and effective communication methods. A purposive sampling strategy was used to recruit diverse participants who reflect the communities with the highest burden of HIV infection. RESULTS: Of 28 study participants, the median age was 28 years (interquartile range [IQR]: 25, 35). The sample comprised B/AA (39%, n = 11) and H/L (50%, n = 14) individuals. Notably, nearly half of the participants (46%) were current PrEP users. We found that many participants were in favor of using a PDI approach for promoting PrEP. Additionally, several participants showed interest in becoming peer educators themselves. They emphasized the need for strong communication skills to effectively teach others about PrEP. Moreover, participants noted that peer education should cover key topics like how PrEP works, how effective it is, and any possible side effects. CONCLUSIONS: Our study shows that effective PDIs, facilitated by well-trained peers knowledgeable about PrEP, could enhance PrEP uptake among MSM, addressing health disparities and potentially reducing HIV transmission in B/AA and H/L communities.
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Infecciones por VIH , Homosexualidad Masculina , Grupo Paritario , Profilaxis Pre-Exposición , Investigación Cualitativa , Humanos , Masculino , Profilaxis Pre-Exposición/estadística & datos numéricos , Profilaxis Pre-Exposición/métodos , Homosexualidad Masculina/psicología , Homosexualidad Masculina/estadística & datos numéricos , Adulto , Infecciones por VIH/prevención & control , New England , Entrevistas como Asunto , Negro o Afroamericano/estadística & datos numéricos , Negro o Afroamericano/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Hispánicos o Latinos/psicología , Hispánicos o Latinos/estadística & datos numéricos , Fármacos Anti-VIH/uso terapéutico , Fármacos Anti-VIH/administración & dosificaciónRESUMEN
BACKGROUND: Cancer predisposition syndromes (CPS) impact about 10% of patients with pediatric cancer. Genetic testing (CPS-GT) has multiple benefits, but few studies have described parent and child knowledge and attitudes regarding CPS-GT decision-making. This study examined parent and patient CPS-GT decision-making knowledge and attitudes. PROCEDURE: English- or Spanish-speaking parents of children with pediatric cancer and patients with pediatric cancer ages 15-18 within 12 months of diagnosis or relapse were eligible to participate. Seventy-five parents and 19 parent-patient dyads (N = 94 parents, 77.7% female, 43.6% Latino/a/Hispanic; 19 patients, 31.6% female) completed surveys measuring CPS-GT-related beliefs. Independent samples t-tests compared parent responses across sociodemographic characteristics and parent-patient responses within dyads. RESULTS: Spanish-speaking parents were significantly more likely than English-speaking parents to believe that CPS-GT not being helpful (p < .001) and possibly causing personal distress (p = .002) were important considerations for deciding whether to obtain CPS-GT. Parents with less than four-year university education, income less than $75,000, or Medicaid (vs. private insurance) were significantly more likely to endorse that CPS-GT not being helpful was an important consideration for deciding whether to obtain CPS-GT (p < .001). Parents felt more strongly than patients that they understood what CPS-GT was (p = .01) and that parents should decide whether patients under 18 should receive CPS-GT (p = .002). CONCLUSIONS: Spanish-speaking parents and parents with lower socioeconomic statuses were more strongly influenced by the potential disadvantages of CPS-GT in CPS-GT decision-making. Parents felt more strongly than patients that parents should make CPS-GT decisions. Future studies should investigate mechanisms behind these differences and how to best support CPS-GT knowledge and decision-making.
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Predisposición Genética a la Enfermedad , Pruebas Genéticas , Conocimientos, Actitudes y Práctica en Salud , Padres , Humanos , Femenino , Masculino , Adolescente , Padres/psicología , Adulto , Niño , Neoplasias/genética , Neoplasias/psicología , Neoplasias/diagnóstico , Toma de Decisiones , Encuestas y Cuestionarios , Hispánicos o Latinos/psicología , Hispánicos o Latinos/estadística & datos numéricos , Hispánicos o Latinos/genética , Persona de Mediana Edad , Factores Sociodemográficos , Factores SocioeconómicosRESUMEN
Importance: Determining the influence of race and ethnicity on change in cognitive test performance has significant implications for clinical practice and research in populations at risk for Alzheimer disease. Objective: To evaluate the significance of race and ethnicity in predicting longitudinal cognitive test performance and to develop models to support evidence-based practice. Design, Setting, and Participants: This prognostic study included baseline and 24-month follow-up data that were obtained from the Health and Aging Brain Study-Health Disparities (HABS-HD) study, an ongoing longitudinal observational study of aging and dementia in a multiracial, multiethnic cohort. Participants included community-dwelling adults and elders living in the Dallas and Fort Worth metropolitan area who were Hispanic and non-Hispanic adults older than the age of 50 years and were cognitively unimpaired. Exposure: The primary exposure of interest was time, measured in months. Main Outcomes and Measures: Demographic variables included age, sex, education, and race and ethnicity. Cognitive domains included attention and working memory, processing speed, language, memory, and executive functioning. Linear regression models predicted follow-up performance from baseline performance and demographic variables for 13 commonly used neuropsychological tests. Follow-up testing was the primary outcome for all domains. Raw scores from 13 standardized tests were used for analyses. Results: This study included 799 adults who were cognitively unimpaired (352 Hispanic individuals [44.1%]; 447 non-Hispanic individuals [55.9%]; 524 female [65.6%]; mean [SD] age, 65.4 [8.1] years). In the regression models, all 13 follow-up scores were significantly predicted from their respective baseline scores and demographic variables. Baseline performance and education were the most consistent predictors of follow-up scores, contributing to all 13 models. Age was significantly associated with follow-up in 11 models, and sex was significant in 5 models. Race and ethnicity contributed to 10 of 13 models, with Hispanic participants predicted to have poorer follow-up scores than their non-Hispanic White counterparts on each test. Conclusions and Relevance: In this longitudinal study of cognitive change in Hispanic and non-Hispanic older adults who were cognitively unimpaired, standardized regression-based models were influenced by multiple demographic variables, including race and ethnicity. These findings highlight the importance of including race and ethnicity in such cognitive change models. This ability to accurately predict cognitive change is expected to become increasingly important as clinical practice and clinical trials need to become more diverse and culturally appropriate in this burgeoning global medical and societal crisis.
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Cognición , Hispánicos o Latinos , Pruebas Neuropsicológicas , Humanos , Femenino , Masculino , Hispánicos o Latinos/estadística & datos numéricos , Hispánicos o Latinos/psicología , Anciano , Persona de Mediana Edad , Estudios Longitudinales , Pruebas Neuropsicológicas/estadística & datos numéricos , Disfunción Cognitiva/etnología , Anciano de 80 o más Años , Envejecimiento/psicología , Envejecimiento/etnologíaRESUMEN
Importance: In the US, infants born to non-Hispanic Black birthing parents are 50% more likely to be born preterm than those born to non-Hispanic White birthing parents, and individual-level factors do not fully account for this inequity. Neighborhood context, rooted in historic patterns of structural racism, may facilitate understanding patterns of inequity in preterm birth. Objective: To estimate the association between neighborhood opportunity level, measured by the Child Opportunity Index (COI), and preterm birth among infants in Massachusetts. Design, Setting, and Participants: In this cross-sectional, population-based study, Massachusetts birth certificates from 3 large metropolitan areas (Boston, Springfield, and Worcester) were linked to US Census tract-level data from the COI, and log binomial regression models and generalized estimating equations were fit to examine associations of different levels of opportunity with preterm birth. Singleton infants born in Massachusetts between February 1, 2011, and December 31, 2015, were included. Analyses were originally conducted in 2019 and updated in 2024. Exposure: Level of child opportunity (measured by the COI) at the US Census tract level. Race and ethnicity were ascertained from the birth certificate, as reported by the birthing parent. Main Outcomes and Measures: Live birth before 37 completed weeks' gestation. Results: The analytic dataset included 267â¯553 infants, of whom 18.9% were born to Hispanic, 10.1% to non-Hispanic Asian or Pacific Islander, 10.1% to non-Hispanic Black, and 61.0% to non-Hispanic White birthing parents. More than half of infants born to non-Hispanic Black and Hispanic birthing parents were born into very low opportunity neighborhoods, and in crude models, this was associated with greater prevalence of preterm birth relative to very high opportunity neighborhoods (prevalence ratio, 1.44; 95% CI, 1.37-1.52). After adjustment for covariates, infants born into very low opportunity neighborhoods still had a greater prevalence of preterm birth (prevalence ratio, 1.16; 95% CI, 1.10-1.23). Conclusions and Relevance: In this cross-sectional study of neighborhood opportunity and preterm birth, elevated risk associated with exposure to a very low opportunity neighborhood, coupled with the disproportionate exposure by race and ethnicity, points to a modifiable factor that may contribute to racial and ethnic inequities in preterm birth. Future research should investigate interventions that seek to address neighborhood opportunity.
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Nacimiento Prematuro , Humanos , Nacimiento Prematuro/etnología , Nacimiento Prematuro/epidemiología , Estudios Transversales , Femenino , Recién Nacido , Massachusetts/epidemiología , Adulto , Masculino , Embarazo , Características del Vecindario/estadística & datos numéricos , Etnicidad/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Población Blanca/estadística & datos numéricos , Negro o Afroamericano/estadística & datos numéricos , Grupos Raciales/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricosRESUMEN
Pre-exposure prophylaxis (PrEP) is a highly effective tool to prevent HIV, yet it is underutilized among women. The current study aims to evaluate the awareness, attitudes, and perceptions of PrEP among a large survey sample of Black and Latina women in New York City (NYC). Interviewer-administered surveys were conducted in high HIV incidence neighborhoods in NYC among Black, Latina, and Afro-Latina women who reported recent sex with a man in 2017 (n = 398) and 2018 (n = 405). About 40% of participants were aware of PrEP, whereas 30.4% indicated interest in using it. The top reason for not utilizing it was low HIV risk perception. However, most participants supported the idea that using PrEP meant asserting control over their health (94.1%). Primary care providers and obstetricians/gynecologists were participants' preferred sources for PrEP (91.6%). Across survey cycles, compared to non-Black Latina participants, Black participants had significantly higher PrEP awareness (44.4% vs. 29.1%). PrEP awareness was also significantly higher among survey participants in 2018 (45.2%) than in 2017 (34.3%). Less than half of the participants were aware of PrEP, but those who were aware expressed largely positive attitudes toward the medication. Our findings may inform future PrEP implementation strategies to optimize awareness and access to PrEP among women disproportionately affected by HIV, like focusing on personal empowerment instead of risk-based messaging and training women's sexual health care providers in PrEP provision.
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Negro o Afroamericano , Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Hispánicos o Latinos , Profilaxis Pre-Exposición , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Adulto Joven , Fármacos Anti-VIH/uso terapéutico , Fármacos Anti-VIH/administración & dosificación , Negro o Afroamericano/psicología , Negro o Afroamericano/estadística & datos numéricos , Encuestas Epidemiológicas , Hispánicos o Latinos/psicología , Hispánicos o Latinos/estadística & datos numéricos , Infecciones por VIH/prevención & control , Infecciones por VIH/etnología , Infecciones por VIH/psicología , Ciudad de Nueva York/epidemiología , Aceptación de la Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/psicología , Profilaxis Pre-Exposición/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Salud Sexual/etnologíaRESUMEN
INTRODUCTION: Studies suggest disparities in outcomes in minoritized children after severe traumatic brain injury. We aimed to evaluate for disparities in intracranial pressure-directed therapies and outcomes after pediatric severe traumatic brain injury. METHODS: We conducted a secondary analysis of the Approaches and Decisions for Acute Pediatric TBI (ADAPT) Trial, which enrolled pediatric severe traumatic brain injury patients (Glasgow Coma Scale score ≤8) with an intracranial pressure monitor from 2014 to 2018. Patients admitted outside of the United States were excluded. Patients were categorized by race and ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White, and "Other"). We evaluated outcomes by assessing mortality and 3-month Glasgow Outcome Score-Extended for Pediatrics. Our analysis involved parametric and nonparametric testing. MAIN RESULTS: A total of 671 children were analyzed. Significant associations included older age in non-Hispanic White patients (P < .001), more surgical evacuations in "Other" (P < .001), and differences in discharge location (P = .040). The "other" cohort received hyperventilation less frequently (P = .046), although clinical status during Paco2 measurement was not known. There were no other significant differences in intracranial pressure-directed therapies. Hispanic ethnicity was associated with lower mortality (P = .004) but did not differ in unfavorable outcome (P = .810). Glasgow Outcome Score-Extended for Pediatrics was less likely to be collected for non-Hispanic Black patients (69%; P = .011). CONCLUSIONS: Our analysis suggests a general lack of disparities in intracranial pressure-directed therapies and outcomes in children after severe traumatic brain injury. Lower mortality in Hispanic patients without a concurrent decrease in unfavorable outcomes, and lower availability of Glasgow Outcome Score-Extended for Pediatrics score for non-Hispanic Black patients merit further investigation.
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Lesiones Traumáticas del Encéfalo , Disparidades en Atención de Salud , Presión Intracraneal , Humanos , Lesiones Traumáticas del Encéfalo/terapia , Lesiones Traumáticas del Encéfalo/etnología , Lesiones Traumáticas del Encéfalo/mortalidad , Niño , Femenino , Masculino , Preescolar , Adolescente , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Presión Intracraneal/fisiología , Resultado del Tratamiento , Hispánicos o Latinos/estadística & datos numéricos , Etnicidad , Lactante , Negro o Afroamericano/estadística & datos numéricos , Escala de Consecuencias de Glasgow , Población Blanca/estadística & datos numéricosRESUMEN
BACKGROUND AND OBJECTIVES: Epilepsy is common among older adults, but previous incident studies have had limited ability to make comparisons across key subgroups. We aimed to provide updated epilepsy incidence estimates among older adults, comparing across age, sex, and race/ethnicity. METHODS: Using a random sample of 4,999,999 US Medicare beneficiaries older than 65 years, we conducted a retrospective cohort study of epilepsy incidence using administrative claims for 2016-2019. Sampled beneficiaries were enrolled in the Fee-for-Service (FFS) program in each of 2016-2018 and had no epilepsy claims in those years. Non-Hispanic Black and Hispanic beneficiaries were oversampled to ensure adequate cases for detailed comparisons. Incidence in 2019 was identified in the Master Beneficiary Summary File as ≥1 inpatient claim or ≥2 outpatient nondrug claims occurring at least 1 day apart (ICD-10 G40.x). Incidence models were estimated by age, sex, race/ethnicity, and combinations thereof, with adjustment for the racial/ethnic oversampling. RESULTS: We identified 20,545 incident epilepsy cases. The overall epilepsy incidence rate (IR) was 393 per 100,000 (99% CI 385-400). Incidence peaked at ages 85-89 (504 [481-529]) and was higher for men (396 [385-407]) than women (376 [366-385]). The sex difference in IRs was constant with age. Incidence was higher for non-Hispanic Black (678 [653-702]) and Hispanic (405 [384-426]), and lower for non-Hispanic Asian/Pacific Islander (272 [239-305]) beneficiaries, compared with non-Hispanic White beneficiaries (354 [299-408]). The age-specific IRs significantly differed by race/ethnicity and sex, but only among non-Hispanic Black beneficiaries-where men had higher rates at younger ages and women at older ages. DISCUSSION: We found higher epilepsy IRs among those enrolled in the Medicare FFS system 2016-2019 than previous studies using Medicare claims data from at least a decade ago. The risk of epilepsy onset is higher for those in their late 80s, men, and non-Hispanic Black and Hispanic older adults. There is also evidence that these age-graded risks operate differently for Black men and Black women. Efforts to provide care and services that improve quality of life for older adults living with epilepsy should consider differences by multiple social characteristics simultaneously: age, sex, and race/ethnicity.
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Epilepsia , Medicare , Humanos , Estados Unidos/epidemiología , Masculino , Femenino , Anciano , Epilepsia/epidemiología , Epilepsia/etnología , Incidencia , Anciano de 80 o más Años , Estudios Retrospectivos , Etnicidad , Factores Sexuales , Factores de Edad , Hispánicos o Latinos/estadística & datos numéricos , Estudios de Cohortes , Grupos Raciales , Negro o AfroamericanoRESUMEN
OBJECTIVE: The current study aimed to explore changes in health-related behaviors and social practices in Hispanic cancer patients during a government-mandated lockdown and their relationship to sociodemographic and clinical characteristics. METHODS: Secondary analyses were conducted on data gathered by a longitudinal cohort study to describe the unmet needs of Hispanic cancer patients living in Puerto Rico exposed to Hurricane Maria in 2017, earthquakes in 2020, and COVID-19. However, our study solely focuses on the data from the COVID-19 pandemic period. RESULTS: Most participants were women (n = 72) with breast cancer (81.2%). Participants exhibited changes in religious practices (60%), physical activity (58.4%), and sedentary behavior (50%); 31.4% experienced changes in eating habits and sleeping patterns. Responses to the study questionnaire involved staying connected with family (85.5%) through phone calls (78.2%); 69.9% of the participants reported observing shifts in the family dynamics. A strong majority endorsed the government-imposed isolation measures (95.6%). Patients not undergoing treatment were likelier (r = -0.324; P = .010) to support the measures. Finally, younger patients experienced more work-related changes (r = -0.288; P = .017) and were less inclined (r = -0.293; P = .011) to find the isolation measures appropriate. CONCLUSION: This paper describes the lockdown related changes in health and social behaviors sustained by cancer patients, changes which could potentially impact their overall health and health-related quality of life. Our results fill an existing gap in our findings and contribute to understanding the experiences of cancer patients (in particular, Hispanic patients) during the COVID-19 pandemic.
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COVID-19 , Hispánicos o Latinos , Neoplasias , Humanos , COVID-19/epidemiología , Femenino , Masculino , Persona de Mediana Edad , Hispánicos o Latinos/estadística & datos numéricos , Estudios Longitudinales , Adulto , Puerto Rico , Conductas Relacionadas con la Salud , Anciano , Encuestas y Cuestionarios , Cuarentena/psicología , Ejercicio Físico , Conducta Sedentaria , Neoplasias de la MamaRESUMEN
OBJECTIVE: Childbirth is considered to be both beautiful and traumatic. Following a vaginal delivery, some women express discontent with the appearance of their genitalia on social media and/or websites. This study explored how some women perceived their genitalia, post childbirth. Three groups were compared: women with a vaginal delivery, those with a cesarean-section, and those who had never given birth. METHODS: After the study received approval from the institutional review board, 224 female participants living in Puerto Rico and aged 21 to 42 years completed a questionnaire about their genital self-image. RESULTS: Approximately 51% (n = 115) of the participants had never given birth; the others had given birth via C-section 23% (n = 51) or vaginally 26% (n = 58). In all 3 groups, 84% felt positive about their genitals, 79% expressed their satisfaction with the appearance of their genitals and 84%, with their size; 81% were not ashamed of their genitals. CONCLUSION: Logistic regression found no significant difference in genital self-perception between delivery groups or nulliparous women. The adjusted odds ratios for positive genital image varied slightly between delivery methods but were not statistically significant (ranging from 0.65 to 1.11 for vaginal deliveries, and 0.42 to 1.00 for C-sections; P > .05). This suggests that the method of delivery does not have a significant impact on women's genital self-perception. However, for the 21% with negative perceptions, targeted support is essential; for those struggling with their self-image after childbirth, our results can inform support services to address concerns.
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Cesárea , Parto Obstétrico , Hispánicos o Latinos , Autoimagen , Humanos , Femenino , Puerto Rico , Adulto , Adulto Joven , Parto Obstétrico/psicología , Hispánicos o Latinos/estadística & datos numéricos , Encuestas y Cuestionarios , Cesárea/estadística & datos numéricos , Genitales Femeninos , Embarazo , Paridad , Imagen Corporal/psicologíaRESUMEN
BACKGROUND: Infant mortality continues to be a significant problem for patients with congenital heart disease (CHD). Limited data exist on the recent trends of mortality in infants with CHD. METHODS: The CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) was queried to identify deaths occurring within the United States with CHD listed as one of the causes of death between 1999 and 2020. Subsequently, trends were calculated using the Joinpoint regression program (version 4.9.1.0; National Cancer Institute). RESULTS: A total of 47,015 deaths occurred in infants due to CHD at the national level from the year 1999 to 2020. The overall proportional infant mortality (compared to all deaths) declined (47.3% to 37.1%, average annual percent change [AAPC]: -1.1 [95% CI -1.6 to -0.6, p < 0.001]). There was a significant decline in proportional mortality in both Black (45.3% to 34.3%, AAPC: -0.5 [-0.8 to -0.2, p = 0.002]) and White patients (55.6% to 48.6%, AAPC: -1.2 [-1.7 to -0.7, p = 0.001]), with a steeper decline among White than Black patients. A statistically significant decline in the proportional infant mortality in both non-Hispanic (43.3% to 33.0%, AAPC: -1.3% [95% CI -1.9 to -0.7, p < 0.001]) and Hispanic (67.6% to 57.7%, AAPC: -0.7 [95% CI -0.9 to -0.4, p < 0.001]) patients was observed, with a steeper decline among non-Hispanic infant population. The proportional infant mortality decreased in males (47.5% to 53.1%, AAPC: -1.4% [-1.9 to -0.9, p < 0.001]) and females (47.1% to 39.6%, AAPC: -0.9 [-1.9 to 0.0, p = 0.05]). A steady decline in for both females and males was noted. CONCLUSION: Our study showed a significant decrease in CHD-related mortality rate in infants and age-adjusted mortality rate (AAMR) between 1999 and 2020. However, sex-based, racial/ethnic disparities were noted, with female, Black, and Hispanic patients showing a lesser decline than male, White, and non-Hispanic patients.
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Centers for Disease Control and Prevention, U.S. , Cardiopatías Congénitas , Mortalidad Infantil , Humanos , Cardiopatías Congénitas/mortalidad , Estados Unidos/epidemiología , Masculino , Femenino , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Estudios de Cohortes , Hispánicos o Latinos/estadística & datos numéricos , Causas de Muerte/tendencias , Población BlancaRESUMEN
BACKGROUND: Suicidal ideation (SI) and suicide attempts (SA) are risk factors for suicide which peak during adolescence; however, evidence focused on differences in SI and SA risk among racial/ethnic minority youth is limited despite increasing suicide rates among several racial/ethnic minority groups. METHODS: We analyzed a representative sample of adolescents aged 12-17 with prior depressive symptoms (n = 32,617) from the cross-sectional National Surveys on Drug Use and Health (2008-2019). Survey-weighted adjusted logistic regressions estimated the association of race/ethnicity with self-reported lifetime SI and SA, controlling for sociodemographics, lifetime substance use, lifetime major depressive episode, and self-rated health. RESULTS: Compared to white adolescents, Black and Hispanic adolescents had a 2.5 % (p = 0.04) and 4.2 % (p < 0.001) lower likelihood of reporting SI. However, among participants reporting SI, Black and Hispanic adolescents had a 3.2 % (p = 0.03) and 3.1 % (p = 0.03) higher likelihood of reporting SA than white adolescents. Multiracial adolescents were 5.9 % (p = 0.03) more likely to report SA than white adolescents. LIMITATIONS: Although racial/ethnic minority groups are less likely to self-report mental health symptoms, we could only assess SI/SA among adolescents self-reporting prior depressive symptoms, and we could only assess SA among adolescents self-reporting SI due to survey methods. CONCLUSIONS: Variation in the racial/ethnic distribution of suicidality supports theories conceptualizing separate pathways for SI and SA. This underscores the need for greater attention to racial/ethnic differences in suicide-related research, surveillance, and prevention efforts, including ensuring that mental health risk assessments directly evaluate SA in addition to SI in order to better identify high-risk racial/ethnic minority youth.
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Ideación Suicida , Intento de Suicidio , Adolescente , Niño , Femenino , Humanos , Masculino , Negro o Afroamericano/estadística & datos numéricos , Negro o Afroamericano/psicología , Estudios Transversales , Etnicidad/estadística & datos numéricos , Etnicidad/psicología , Hispánicos o Latinos/estadística & datos numéricos , Hispánicos o Latinos/psicología , Factores de Riesgo , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/etnología , Intento de Suicidio/psicología , Estados Unidos/epidemiología , Blanco/psicología , Blanco/estadística & datos numéricosRESUMEN
The HIV Index is a validated self-report scale of engagement in HIV care previously correlated with future retention and virologic suppression. However, its performance in a monoethnic Latinx population has not been studied. We evaluated the HIV Index among Latinx persons living with HIV in the Centers for AIDS Research Network of Integrated Clinical Systems cohort and performed multivariable logistic regression to estimate its association with primary outcomes of suboptimal retention (not keeping 100% of HIV clinic appointments) and virologic suppression (HIV viral load <200 copies/mL). The mean Index score was 4.5 (standard deviation 0.6) in both analytic samples, indicative of feeling well-engaged. Higher Index scores were associated with lower odds of suboptimal retention (OR = 0.12, 95% CI [0.03, 0.54], p = .005), however, there was no association between Index score and virologic suppression. The HIV Index is useful for assessing engagement and retention among Latinx PLWH in routine care.
Asunto(s)
Infecciones por VIH , Hispánicos o Latinos , Retención en el Cuidado , Carga Viral , Humanos , Infecciones por VIH/etnología , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Masculino , Adulto , Retención en el Cuidado/estadística & datos numéricos , Persona de Mediana Edad , Fármacos Anti-VIH/uso terapéutico , Autoinforme , Modelos Logísticos , Estudios de Cohortes , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: This study aims to describe patterns, sources, and reasons for cannabis use among cancer patients by ethnic group. METHODS: Data are from a cross-sectional study of 416 surveys collected via RedCap anonymously from adult cancer patients seen at a National Cancer Institute-designated comprehensive cancer center within the last 5 years. A harmonized survey was created with 11 other National Cancer Institute centers to assess cannabis use patterns, sources, and reasons for use. Sociodemographics and cancer details were also collected via self-report. Descriptive statistics by ethnic group were compared using χ2 and Fisher exact tests. RESULTS: Among the sample (age mean = 50.4 [15.7] years; 53% male; 8.3% lesbian, gay, bisexual, transgender, queer; 46.7% Hispanic and Latinx individuals), 69.6% reported lifetime use of cannabis, 33.7% began cannabis use after cancer diagnosis, 48.1% of those consuming cannabis did not have a prescription for cannabis, and 29.4% of cannabis users consumed daily. The frequency of cannabis use (P = .04) and reasons for cannabis use (P = .02) varied by ethnic group. Sleep and pain were the most prevalent reasons for use among the Hispanics and Latinx populations; pain, mental health management, and neuropathy were the most prevalent reasons for cannabis use among non-Hispanic White individuals. CONCLUSIONS: Patterns and reasons for cannabis use differed among cancer patients by ethnic group in this exploratory cross-sectional study aimed to provide data for more rigorous study. Understanding these distinctions are pivotal in conducting more rigorous studies that address the unique needs of diverse populations utilizing cannabis for managing cancer-related symptoms.
Asunto(s)
Etnicidad , Marihuana Medicinal , Neoplasias , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Instituciones Oncológicas/estadística & datos numéricos , Estudios Transversales , Etnicidad/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Marihuana Medicinal/uso terapéutico , National Cancer Institute (U.S.) , Neoplasias/epidemiología , Encuestas y Cuestionarios , Estados Unidos/epidemiologíaRESUMEN
(1) Background: Branched-chain and aromatic amino acids (BCAAs/AAAs) have been considered as markers of type 2 diabetes (T2D); however, studies on associations between these metabolites and T2D and cardiometabolic traits in Hispanic populations are limited. The aim of this study was to examine the associations between baseline BCAAs (isoleucine, leucine, valine)/AAAs (phenylalanine, tyrosine) and prevalent and incident T2D, as well as baseline and longitudinal (2 year) changes in cardiometabolic traits (measures of glycemia, dyslipidemia, inflammation, and obesity) in two large cohorts of adults of Puerto Rican descent. (2) Methods: We included participants of the Boston Puerto Rican Health Study (BPRHS, n = 670) and San Juan Overweight Adult Longitudinal study (SOALS, n = 999) with available baseline metabolite and covariate data. T2D diagnosis was defined based on American Diabetes Association criteria. Multivariable logistic (for baseline T2D), Poisson (for incident T2D), and linear (for cardiometabolic traits) regression models were used; cohort-specific results were combined in the meta-analysis and adjusted for multiple comparisons. (3) Results: Higher baseline BCAAs were associated with higher odds of prevalent T2D (OR1SD BCAA score = 1.46, 95% CI: 1.34-1.59, p < 0.0001) and higher risk of incident T2D (IRR1SD BCAA score = 1.24, 95% CI: 1.13-1.37, p < 0.0001). In multivariable longitudinal analysis, higher leucine and valine concentrations were associated with 2-year increase in insulin (beta 1SD leucine = 0.37 mcU/mL, 95% CI: 0.11-0.63, p < 0.05; beta 1SD valine = 0.43 mcU/mL, 95% CI: 0.17-0.68, p < 0.01). Tyrosine was a significant predictor of incident T2D (IRR = 1.31, 95% CI: 1.09-1.58, p < 0.05), as well as 2 year increases in HOMA-IR (beta 1SD tyrosine = 0.13, 95% CI: 0.04-0.22, p < 0.05) and insulin concentrations (beta 1SD tyrosine = 0.37 mcU/mL, 95% CI: 0.12-0.61, p < 0.05). (4) Conclusions: Our results confirmed the associations between BCAAs and prevalent and incident T2D, as well as concurrent measures of glycemia, dyslipidemia, and obesity, previously reported in predominantly White and Asian populations. Baseline leucine, valine, and tyrosine were predictors of 2 year increases in insulin, whereas tyrosine was a significant predictor of deteriorating insulin resistance over time. Our study suggests that BCAAs and tyrosine could serve as early markers of future glycemic changes in Puerto Ricans.
Asunto(s)
Aminoácidos Aromáticos , Aminoácidos de Cadena Ramificada , Factores de Riesgo Cardiometabólico , Diabetes Mellitus Tipo 2 , Hispánicos o Latinos , Humanos , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/sangre , Femenino , Masculino , Persona de Mediana Edad , Aminoácidos de Cadena Ramificada/sangre , Aminoácidos Aromáticos/sangre , Adulto , Hispánicos o Latinos/estadística & datos numéricos , Estudios Longitudinales , Puerto Rico/epidemiología , Puerto Rico/etnología , Anciano , Prevalencia , Boston/epidemiología , Incidencia , Obesidad/epidemiología , Obesidad/etnologíaRESUMEN
Justice-involved young adult (JIYA) men are at high risk for HIV, yet frequently do not access HIV services. A better understanding of testing behaviors and motivation, as well as facilitators and barriers to testing is necessary for treatment-as-prevention approaches to be implemented among JIYA. Seventeen JIYA men and nine staff were recruited from three alternative sentencing programs (ASPs). In-depth interviews and a staff focus group explored HIV risk and testing uptake behaviors. Narratives from JIYA demonstrated a lack of connection among HIV risk and behavior, views on testing, and knowledge of PreP. Youth and staff also disclosed various youth and environmental/structural barriers to HIV testing. The justice system may be a crucial point of intervention to reduce HIV risk and promote HIV testing with interventions targeted to the needs of JIYA.
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Negro o Afroamericano , Infecciones por VIH , Prueba de VIH , Hispánicos o Latinos , Profilaxis Pre-Exposición , Humanos , Masculino , Infecciones por VIH/prevención & control , Infecciones por VIH/etnología , Infecciones por VIH/diagnóstico , Adulto Joven , Negro o Afroamericano/psicología , Negro o Afroamericano/estadística & datos numéricos , Hispánicos o Latinos/psicología , Hispánicos o Latinos/estadística & datos numéricos , Adolescente , Adulto , Conocimientos, Actitudes y Práctica en Salud/etnología , Asunción de Riesgos , Grupos Focales , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/psicologíaRESUMEN
Research has established relationships between social determinants of health (SDOH) and mental health, with mixed findings on which ethnoracial groups are most vulnerable to deleterious outcomes. The current study examines ethnoracial differences in SDOH and their associations with acute mental health symptoms among patients hospitalized after emergency care. Using data collected in a multi-site study of 1,318 diverse adults admitted to inpatient units, we performed analyses using linear regression models. Findings show that Multiracial/Indigenous and Black adults had significantly higher discrimination and financial stress scores. However, compared with White adults, the positive association between extreme discrimination and acute mental health symptoms was diminished among Latinx (B=-2.3; p=.02) and Black individuals (B=-1.6; p=.05) as was the positive association between financial insecurity and acute mental health symptoms for Black adults (B=-2.3; p=.04). This study provides evidence of differential experiences of SDOH and mental health challenges that may warrant tailored interventions.
Asunto(s)
Determinantes Sociales de la Salud , Humanos , Determinantes Sociales de la Salud/etnología , Masculino , Femenino , Adulto , Persona de Mediana Edad , Hospitalización/estadística & datos numéricos , Negro o Afroamericano/estadística & datos numéricos , Negro o Afroamericano/psicología , Trastornos Mentales/etnología , Estrés Financiero/etnología , Estrés Financiero/psicología , Hispánicos o Latinos/psicología , Hispánicos o Latinos/estadística & datos numéricos , Población Blanca/estadística & datos numéricos , Población Blanca/psicología , Salud Mental/etnología , Adulto Joven , Etnicidad/estadística & datos numéricos , Etnicidad/psicología , Anciano , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: During the first nine months of the COVID-19 emergency, patients were encouraged to use virtual versus clinic visits if in-person care was not deemed necessary by clinical staff. This study examined the association of spoken language preference and ethnicity with use of video versus phone virtual visits by US Latino and Chinese adult patients who got care in the same healthcare system. METHODS: We analyzed electronic health record data for four groups of adults aged 26-85y who had ≥ 1 primary or specialty care outpatient clinician visits during April-December 2020: 80,869 Latino adults preferring Spanish (LEP Latino); 214,765 Latino adults preferring English (non-LEP Latino); 23,430 Chinese adults preferring a Chinese dialect (LEP Chinese); and 49,710 Chinese adults preferring English (non-LEP Chinese). Prevalence of the following utilization outcomes were compared by language preference (LEP/non-LEP) within ethnicity and by ethnicity within language preference for four age subgroups (26-39y, 40-64y, 65-75y, and 76-85y): ≥ 1 virtual (video or phone) visit, ≥ 1 video visit, ≥ 1 phone visit, ≥ 1 clinic visit, video visits only, and phone visits only. We also compared ethnicity x language group differences within age subgroups using absolute difference and adjusted prevalence ratios derived from modified log-Poisson regression models that controlled for age and sex. RESULTS: Among virtual users, LEP Latino and Chinese adults were significantly less likely to use video visits and more likely to use phone visits than non-LEP Latino and Chinese adults in the same age strata. The LEP/non-LEP difference in video visit use was significantly larger among Latino than Chinese patients, with no similar ethnic group difference observed for phone visits. Within the LEP and non-LEP language groups, Chinese adults were significantly more likely than Latino adults to use video visits and less likely to use phone visits. CONCLUSIONS: During the first nine months of the COVID-19 pandemic, uptake of video and phone virtual visits by Latino and Chinese adults significantly differed by LEP/non-LEP status within ethnicity and by ethnicity within LEP/non-LEP language group. These findings underscore the importance of disaggregating data by ethnicity and language preference when attempting to understand and study patient use of different virtual visit modalities.
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Asiático , COVID-19 , Registros Electrónicos de Salud , Hispánicos o Latinos , Lenguaje , Humanos , COVID-19/epidemiología , COVID-19/etnología , Persona de Mediana Edad , Masculino , Femenino , Adulto , Hispánicos o Latinos/estadística & datos numéricos , Anciano , Estudios Transversales , Registros Electrónicos de Salud/estadística & datos numéricos , Estados Unidos/epidemiología , Asiático/estadística & datos numéricos , Asiático/psicología , Anciano de 80 o más Años , SARS-CoV-2 , Telemedicina/estadística & datos numéricos , Teléfono , Pandemias , Pueblos del Este de AsiaRESUMEN
OBJECTIVE: Health care inequities are common among individuals who speak languages other than English (LOE). Within our PICU, LOE families prefer communication via in-person interpreters (IPI). Spanish-speaking patient families are our largest LOE population; therefore, we sought to increase Spanish IPI utilization for medical updates in the PICU. METHODS: A quality improvement initiative in a 36-bed PICU included: the addition of a dedicated weekday Spanish-speaking IPI, the creation of communication tools, staff education, optimized identification of LOE families, and development of a language dashboard across multiple Plan, Do, Study, Act cycles. The primary outcome was IPI utilization rates for daily medical updates. RESULTS: Spanish IPI utilization for daily weekday medical updates among 442 Spanish-speaking patient families increased from a median of 39.4% at baseline to a new centerline median of 51.9% during implementation, exhibiting 66.3% (465 of 701) utilization in the final 6 months of implementation. The greatest sustained increases in Spanish IPI utilization occurred after PICU-based IPI implementation, staff education, electronic health record optimization, and a split work week between 2 PICU-based IPIs. CONCLUSIONS: This quality improvement initiative increased Spanish IPI utilization for daily weekday medical updates in the PICU across multiple Plan, Do, Study, Act cycles. Future work will adapt these interventions to other languages and other hospital-based units.